In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was impacted.[1] Coup and contrecoup injuries are associated with cerebral contusions,[2] a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical,[3]
while contrecoup injuries are produced when the moving head strikes a stationary object.[1]

Coup and contrecoup injuries are considered focal brain injuries, those that occur in a particular spot in the brain, as opposed to diffuse injuries, which occur over a more widespread area.[4]

The exact mechanism for the injuries, especially contrecoup injuries, is a subject of much debate.[5] In general, they involve an abrupt deceleration of the head, causing the brain to collide with the inside of the skull. It is likely that inertia is involved in the injuries, e.g. when the brain keeps moving after the skull is stopped by a fixed object or when the brain remains still after the skull is accelerated by an impact with a moving object.[5] Additionally, movement of cerebrospinal fluid following a trauma may play a role in the injury.[5]

Contents

Coup injury may be caused when, during an impact, the skull is temporarily bent inward and impacts the brain.[6] When the skull bends inward, it may set the brain into motion, causing it to collide with the opposite side of the skull; this will result in a contrecoup injury.[7] The injuries can also be caused solely by acceleration or deceleration, in the absence of an impact.[4] In injuries associated with acceleration or deceleration but with no impact, the brain is thought to bounce off the inside of the skull and hit the opposite side, potentially resulting in both coup and contrecoup injuries.[7] In addition to the skull, the brain may also impact the tentorium, causing a coup injury.[8] Contrecoup injury may be produced by tensile forces.[9]

Cerebrospinal fluid (CSF) is also implicated in the mechanism of coup and contrecoup injuries.[10] One explanation for the contrecoup phenomenon is that CSF, which is denser than the brain, rushes to the area of impact during the injury, forcing the brain back into the other side of the skull. If this is the case, the contrecoup impact happens first.[11]

Contrecoup contusions are particularly common in the lower part of the frontal lobes and the front part of the temporal lobes.[4] A 1978 study found that the contrecoup mechanism was responsible for most of the brain lesions such as contusions and hematomas occurring in the temporal lobes of injured individuals.[14] Injuries that occur in body parts other than the brain, such as the lens of the eye,[2] the lung,[15] and the skull[16] and other bones, may also be labelled "contrecoup". The contrecoup mechanism can play a role in pulmonary contusion.[17]

In the 17th century, Jean Louis Petit described contrecoup injuries.[18] In 1766, the French surgeon Antoine Louis coordinated a meeting of the Académie Royale de Chirurgie on contrecoup injuries, at which papers were to be presented, one of which would be chosen to receive the respected prize, the Prix de l'Académie Royale de Chirurgie. The presenter of the chosen paper was not awarded the prize because he failed to make recommended changes. In 1768, the group met again on the topic, and Louis Sebastian Saucerotte won the prize for his paper describing contrecoup injuries in humans and experiments on animals and recommending treatments such as bloodletting and application of herbs to patients' heads.[19]